Tackling “Aging Well” at the Institute for the Future’s Health Horizons Conference

I’m just back from a conference hosted by this 30-year-old Palo Alto think tank, the theme of which was “Living Longer/Aging Well.” Most of the attendees were from healthcare and pharmaceutical companies, and I wasn’t sure how hospitable they’d be to my message about the medicalization of old age. In cultures with meaningful social and economic roles for older people, physical health is just one aspect of aging, but in ours, sickness takes center stage. And as the population ages the medical-industrial complex will depend more than ever on the old for its profits. I needn’t have worried; I got a standing ovation. (Okay, so did all the speakers; it was a mandatory “exercise.”) More gratifyingly, many subsequent speakers referenced stuff I said, and I hope I’ll get invited back. One thing we know for sure about the future is that it’s going to contain a lot more old people. Overturning myths and stereotypes about age and aging ought to be central to Institute’s mission across all their research domains, not health alone.

One thing the conference nailed from the get-go was an emphasis on the individual. Program Co-Director Bradley Kreit opened with the health records of a 70-something-year-old man with a number of serious issues, including diabetes and cardiovascular disease, and then a photograph of the person: his trim, tan, father-in-law standing next to his racing bike. A perfect way to make the case that people shouldn’t be reduced to symptoms. Each table also got to interview an older person, ours being a Japanese-American serial entrepreneur, and a series of exercises required us to connect the many Big Ideas floating around the room—these are futurists, after all—to his circumstances. Much time was devoted to technology of all stripes, from caregiving support networks to “cognition enhancement” to offset memory loss—this is Silicon Valley, after all—and there was much confidence in the potential for social shifts and innovations to address the needs of “person-centered aging.”

That optimism was reflected in the conference subtitle, Aging Well, which I took issue with in my Q&A. The positive language is seductive, but it overlooks the role class plays in determining who gets to age in the first place, not to mention how “well” or “poorly.” Everyone can make sensible choices, but barriers like heavy caregiving responsibilities, inadequate health care, and economic hardship make it more difficult. Value-laden language places the burden on the individual by implying that if you end up sick or exhaust your savings, it’s your fault, which is unfair and diverts attention from the underlying social and economic issues. And all the resources in the world can’t insulate against time or luck.

Research Director Rachel Maguire began her summary by pointing out that people in healthcare tend to think of “the future of aging as the future of physical aging,” which is far too narrow a lens. I also liked some of her broad, messy, age-neutral interdisciplinary “Insights”: that workplace wellness programs should include geriatric mental health, support caregiving by and for all ages, and include end-of life discussions and services, and that design should be oriented towards people’s needs and preferences rather than specific age-based cohorts. (Older people need play spaces too. Swing-sets at bus stations in Montreal are used by olders as much as by kids, and Brownsville, Texas, has just undertaken to build first ever playground for people of all ages with handicaps.) Her closing image was of a heavily-tattooed, long-haired, dentistry-free older man smiling on a park bench saying, “I’m happier than a pig in shit.”

“How to we balance big-picture statistics with the humans behind them, to make sure that solutions are truly person-centered and as available to as many humans as possible?” asked Maguire. Good question. I’m glad these guys are chewing on it.